Galatius-Jensen S, Hansen J, Rasmussen V, Bildsøe J, Therboe M, Rosenberg J
Department of Cardiology Hvidovre University Hospital, Denmark.
Br Heart J. 1994 Jul;72(1):23-30. doi: 10.1136/hrt.72.1.23.
To document the trend in arterial hypoxaemia and electrocardiographic abnormalities on the second to sixth nights after acute myocardial infarction.
Nineteen consecutive patients with acute myocardial infarction who were monitored continuously during the night (minimum 2300-0700) with a Holter tape recorder and a pulse oximeter. Fifteen patients were monitored for five nights, one patient for four nights, one patient for three nights, and two patients for two nights.
Five patients had > 30 episodic oxygen desaturations of > or = 5% during the nights of monitoring and many patients had episodes with oxygen desaturations to < 80% ranging from 46% to 61% (from 7/15 to 11/18 patients) during the nights of monitoring. Constant hypoxaemia was found in 11-13% (2/15) of the patients. Simultaneous episodic hypoxaemia and episodic tachycardia was seen in 9/17 (52%) patients on the second night, 11/18 (61%) on the third, 7/15 (46%) on the fourth, 8/15 (53%) on the fifth, and 5/15 (33%) on the sixth night. Simultaneous episodic hypoxaemia and ST deviation was seen in 5/17 (29%) patients on the second night, 3/18 (16%) on the third, 4/15 (26%) on the fourth, in no patients on the fifth, and in 3/5 (20%) on the sixth night. Simultaneous occurrence of episodic hypoxaemia and arrhythmias (supraventricular, ventricular ectopy, and atrioventricular blockade) was seen in 5/17 (29%) on the second night, 4/18 (22%) on the third, 4/15 (26%) on the fourth, 2/15 (14%) on the fifth, and in no patients on the sixth night. Overall, simultaneous occurrence of episodic hypoxaemia and electrocardiographic abnormalities (episodic tachycardia, ST deviations, and arrhythmias) was seen in 11/17 patients (64%) on the second night, 13/18 (72%) on the third, 10/15 (66%) on the fourth, 8/15 (53%) on the fifth, and 7/15 (46%) on the sixth night. One patient who died of cardiogenic shock had simultaneously occurring episodic hypoxaemia and nonsustained ventricular fibrillation on the night before she died.
Episodic and constant hypoxaemia are common during the first week after acute myocardial infarction. Episodic hypoxaemia was associated with electrocardiographic abnormalities in most patients. Thus, episodic nocturnal hypoxaemia may be particularly detrimental to the infarcted myocardium in the early phase after infarction; special attention should therefore be directed towards oxygenation in this group of patients.
记录急性心肌梗死后第二至六晚动脉血氧不足和心电图异常的变化趋势。
19例连续的急性心肌梗死患者，夜间（至少23:00至07:00）使用动态心电图记录仪和脉搏血氧仪进行连续监测。15例患者监测五晚，1例患者监测四晚，1例患者监测三晚，2例患者监测两晚。
5例患者在监测夜间有超过30次发作性氧饱和度下降≥5%，许多患者在监测夜间有发作性氧饱和度降至<80%的情况，比例从46%至61%（从7/15至11/18例患者）。11% - 13%（2/15）的患者存在持续性低氧血症。在第二晚，9/17（52%）的患者同时出现发作性低氧血症和发作性心动过速；第三晚为11/18（61%）；第四晚为7/15（46%）；第五晚为8/15（53%）；第六晚为5/15（33%）。在第二晚，5/17（29%）的患者同时出现发作性低氧血症和ST段偏移；第三晚为3/18（16%）；第四晚为4/15（26%）；第五晚无患者出现；第六晚为3/5（20%）。在第二晚，5/17（29%）的患者同时出现发作性低氧血症和心律失常（室上性、室性早搏及房室传导阻滞）；第三晚为4/18（22%）；第四晚为4/15（26%）；第五晚为2/15（14%）；第六晚无患者出现。总体而言，在第二晚，11/17例患者（64%）同时出现发作性低氧血症和心电图异常（发作性心动过速、ST段偏移及心律失常）；第三晚为13/18（72%）；第四晚为10/15（66%）；第五晚为8/15（53%）；第六晚为7/15（46%）。1例死于心源性休克的患者在死亡前一晚同时出现发作性低氧血症和非持续性室性心动过速。
急性心肌梗死后第一周内发作性和持续性低氧血症很常见。大多数患者发作性低氧血症与心电图异常相关。因此，发作性夜间低氧血症在梗死后早期可能对梗死心肌特别有害；所以应特别关注这组患者的氧合情况。
